Sample Medical Request Letters

This type of letter can request anything from a second opinion to a payment adjustment. As the name suggests, it requests information or a particular course of action from either a doctor or medical facility.

Examples include the letters that request a second opinion, dental/medical records or a patient requesting a dental clinic to adjust the payment due them.


If you are requesting your dental records be forwarded to another dentist, the letter can make do with a few short paragraphs. However, if your are asking a dental clinic to adjust the payment you owe them, the letter may need to be longer to make sure all points are covered and it does a good "selling" job.

The request letter must request, not demand. Besides, it always pays to keep your emotions in check and not to come across as being demanding . . . even in a letter. Include all information you think will help the doctor or medical facility take the necessary step to grant your request as soon as possible. Assume nothing.

[Ms./Mr. Name]

Dear [Ms./Mr. Last name],

I have been a resident of [Town/City] for over [#] years and during all that time I have sought medical care only at the [Medical facility].

Due to a job transfer, I am now relocating to [Town/City] and would like the [Medical facility] to transfer my medical records to the following hospital, care of the Supervisor, Administration and Records:

[Contact details]

My case file number is [#].

My last visit to the [Medical facility] as a patient was in May 2010.

I would also like to take this opportunity to convey my sincere thanks and appreciate the many years of exceptional care that I have experienced at the [Medical facility].

I have not only been an outpatient at the [Medical facility] many times, I have also had four surgeries under its roof. I must say that on almost each occasion, the doctors and support staff went above and beyond the call of duty to make the experience as dignified as it could be.

I especially thank [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name], [Dr./Ms/Mr. Name] and last but not the least, [Dr./Ms/Mr. Name].

I have no hesitation in highly recommending both the [Medical facility] and the doctors who staff it to anyone who cares to listen!

[Identification #]

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